[Federal Register: May 16, 2003 (Volume 68, Number 95)]
[Notices]
[Page 26618-26620]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16my03-94]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-R-77, CMS-1537, CMS-10067, CMS-R-200, CMS-R-
247, CMS-1515/1572, and CMS-668B]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare and Medicaid Services, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid
Services (CMS) (formerly known as the Health Care Financing
Administration (CMS)), Department of Health and Human Services, is
publishing the following summary of proposed collections for public
comment. Interested persons are invited to send comments regarding this
burden estimate or any other aspect of this collection of information,
including any of the following subjects: (1) The necessity and utility
of the proposed information collection for the proper performance of
the agency's functions;
[[Page 26619]]
(2) the accuracy of the estimated burden; (3) ways to enhance the
quality, utility, and clarity of the information to be collected; and
(4) the use of automated collection techniques or other forms of
information technology to minimize the information collection burden.
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Limitation on
Liability and Information Collection Requirements Referenced in 42 CFR
411.404, 411.406, and 411.408; Form No.: CMS-R-77) (OMB 0938-
0465); Use: The Medicare program requires to provide written
notification of noncovered services to beneficiaries by the providers,
practitioners and suppliers. The notification gives the beneficiary,
provider, practitioner or supplier knowledge that Medicare will not pay
for items or services mentioned in the notification. After this
notification, any future claim for the same or similar services will
not be paid by the program and the affected parties will be liable for
the noncovered services.; Frequency: Other: as needed; Affected Public:
Individuals or Households; Number of Respondents: 900,898; Total Annual
Responses: 3,603,592; Total Annual Hours: 300,299.
2. Type of Information Collection Request: Reinstatement, without
change, of a previously approved collection for which approval has
expired; Title of Information Collection: Medicare/Medicaid Hospital
Survey Report Form and Supporting Regulations in 42 CFR 482.2 through
482.57; Form No.: CMS-1537 (OMB 0938-0382); Use: Section
1861(e) of the Social Security Act (the Act) provides that hospitals
participating in Medicare under the Act must meet specific
requirements. These requirements are presented as Condition of
Participation. State agencies must determine compliance with these
conditions through the use of this report form.; Frequency: Other: 3-5
years; Affected Public: State, Local, or Tribal Government, Business or
other for-profit, Not-for-profit institutions; Number of Respondents:
3323; Total Annual Responses: 3323; Total Annual Hours: 553.
3. Type of Information Collection Request: New collection; Title of
Information Collection: Pharmacy Plus Template for Low Income Seniors
under Medicaid; Form No.: CMS-10067 (OMB 0938-0889); Use: The
template for the Pharmacy Plus program for low income seniors under
Medicaid will enable states to apply, via a standard format, to provide
a drug benefit to elderly recipients; use of this format will expedite
the process of obtaining CMS review and approval of an application;
Frequency: Other: 3 years after initial submission for the 1915(c)
waiver; 5 years after initial submission for the 1115 demonstration;
Affected Public: State Government; Number of Respondents: 51; Total
Annual Responses: 25; Total Annual Hours: 115.
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Health Plan
Employer Data and Information Set (HEDIS) and Health Outcome Survey
(HOS) and supporting regulations at 42 CFR 422.152; Form No.: CMS-R-
200) (OMB 0938-0701); Use: The Centers for Medicare and
Medicaid Services (formerly HCFA) collects quality performance measures
in order to hold the Medicare managed care industry accountable for the
care being delivered, to enable quality improvement, and to provide
quality information to Medicare beneficiaries in order to promote
informed choice. It is critical to CMS's mission that we collect and
disseminate information that will help beneficiaries choose among
health plans, contribute to improved quality of care through
identification of improvement opportunities, and assist CMS in carrying
out its oversight and purchasing responsibilities.; Frequency:
Annually; Affected Public: Business or other for-profit, Not-for-profit
institutions, and Individuals or Households; Number of Respondents:
166,709; Total Annual Responses: 70,992; Total Annual Hours: 498,436.
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Expanded Coverage
for Diabetes Outpatient Self-Management Training Services and
Supporting Regulations Contained in 42 CFR 410.141-410.145 and 414.63.;
Form No.: CMS-R-247) (OMB 0938-0818); Use: 42 CFR 410.141-
410.145 and 414.63 provide for uniform coverage of diabetes outpatient
self-management training services. These services include educational
and training services furnished to a beneficiary with diabetes by an
entity approved to furnish the services. The physician or qualified
nonphysician practitioner treating the beneficiary's diabetes certifies
that these services are needed as part of a comprehensive plan of care.
The regulations set forth the quality standards that an entity is
required to meet in order to participate in furnishing diabetes
outpatient self-management training services.; Frequency: On occasion;
Affected Public: Business or other for-profit; Number of Respondents:
1708; Total Annual Responses: 6832; Total Annual Hours: 53,013.5.
6. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Home Health
Agency Survey and Deficiencies Report, Home Health Functional
Assessment Instrument and Supporting Regulations in 42 CFR Part 484.1--
484.52; Form No.: CMS-1515/1572 (OMB 0938-0355); Use: In order
to participate in the Medicare program as a Home Health Agency (HHA)
provider, the HHA must meet Federal Standards. These forms are used to
record information about patients' health and provider compliance with
requirements; Frequency: Annually; Affected Public: Business or other
for-profit, Not-for-profit institutions; Number of Respondents: 7,000;
Total Annual Responses: 14,000; Total Annual Hours: 14,000.
7. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Post Laboratory
Survey Questionnaire--Laboratory, and Supporting Regulations in 42 CFR
493; Form No.: CMS-668B (OMB 0938-0653); Use: To provide an
opportunity and a mechanism for CLIA laboratories surveyed by CMS or
CMS'' agent to express their satisfaction and concerns about the CLIA
survey process; Frequency: Biennially; Affected Public: Business or
other for-profit, Not-for-profit institutions; Number of Respondents:
22,500; Total Annual Responses: 11,250; Total Annual Hours: 2,813.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS's
Web Site address at http://cms.hhs.gov/regulations/pra/default.asp, or
E-mail your request, including your address, phone number, OMB number,
and CMS document identifier, to Paperwork@hcfa.gov, or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 60 days of this notice directly to the CMS Paperwork Clearance
Officer designated at the following address: CMS, Office of Strategic
Operations and Regulatory Affairs, Division of Regulations Development
and Issuances, Attention: Dawn Willinghan, Room: C5-14-03, 7500
Security Boulevard, Baltimore, Maryland 21244-1850
[[Page 26620]]
Dated: May 8, 2003.
Dawn Willinghan,
CMS Reports Clearance Officer, Division of Regulations Development and
Issuances, Office of Strategic Operations and Strategic Affairs.
[FR Doc. 03-12227 Filed 5-15-03; 8:45 am]
BILLING CODE 4120-03-P